After the Sars outbreak of 2003 claimed 299 lives in Hong Kong, a postmortem of the city’s missteps held a handful of senior officials accountable. The most high profile figure was health minister Yeoh Eng-kiong.
By Elizabeth Cheung and Gary Cheung
Published on SCMP, Feb 25, 2020
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- Communication, response time, and facilities all under the spotlight as epidemic takes hold
- For former health minister Yeoh Eng-kiong the current crisis is bringing back painful memories of 17 years ago
After the Sars outbreak of 2003 claimed 299 lives in Hong Kong, a postmortem of the city’s missteps held a handful of senior officials accountable. The most high profile figure was health minister Yeoh Eng-kiong.
A Legislative Council report in 2004 found Yeoh responsible for a catalogue of failings, including insufficient communication with the public, poor supervision of the health department, and inadequate monitoring of the Hospital Authority, which did not have a contingency plan for large-scale outbreaks.
Yeoh had become the city’s health minister in 1999, but after this searing assessment, he bowed to public pressure and resigned, becoming a key fall guy for a crisis that devastated the economy, as tourism dried up and investors stayed away.
As with many Hongkongers who lived through Sars, the current coronavirus epidemic is bringing back painful memories for Yeoh. The minister-turned-academic is now head of public health at Chinese University, which gives him a better vantage point than most to study if the city is handling the current crisis better than it did 17 years ago.
“One of the most important responses for any outbreak is communication,” he said. “It is not simply about handing out leaflets or holding daily press conferences. It is also the understanding of the impact on every sector of the community.”
With the experience of combating Sars, which stands for severe acute respiratory syndrome, together with the swine flu epidemic in 2009, the city’s government was expected to be more adept at handling the coronavirus epidemic. But criticisms have come thick and fast from all quarters. Health care professionals suggest the authorities’ performance is mixed at best, and slow and uncoordinated at worst.
Experts said while Hong Kong had improved its isolation facilities and stockpiles of personal protective equipment, the government did not act fast enough to stay ahead of the rapidly evolving epidemic, which originated in Wuhan, a transport hub of more than 11 million people.
It was tardy on several fronts: it was too tentative in enforcing tougher border restrictions, and slow to secure supply networks for protection equipment. It also lacked the foresight and will to roll out quarantine facilities, as a result of a complacency that had set in over the years, critics said. Since January 23, when the first two cases were officially confirmed, Hong Kong has 81 confirmed infections of Covid-19, the disease caused by the coronavirus, as of Monday morning.
Responses
There is little argument that Sars had made its residents more alert and the authorities more experienced in handling epidemics. Back in 2003, when the first Sars case entered Hong Kong quietly in late February, officials were relatively unprepared.
Health authorities at the time were criticised for their inaction between the time when Hong Kong’s Sars index patient, a professor from Guangzhou, was admitted to Kwong Wah Hospital in late February, and when the Prince of Wales Hospital admitted a close local contact of the professor.
This time, the Hong Kong government reacted more quickly to the coronavirus. It launched a response plan on January 4, and activated it to the “serious” level, the second in a three-tier scale, after Wuhan health authorities revealed to the public on December 31 a cluster of unknown pneumonia cases. That was also after Hong Kong reported a few suspected cases.
Soon after, the government amended the law to make the viral infection, which was then relatively unknown, a statutory notifiable disease.

Professor Yuen Kwok-yung, a top infectious disease expert from the University of Hong Kong (HKU) who is currently advising the government, said the city’s measures had been “three steps ahead” at the beginning, but lagged behind after the first cases were confirmed.
Experts, including HKU’s top microbiologist Dr Ho Pak-leung, made repeated calls to the government to ban visitors coming from mainland China, to prevent more people who might be infected from entering the city. Thousands of health care workers staged an unprecedented strike to urge authorities to do so.
Chief Executive Carrie Lam Cheng Yuet-ngor only moved to shut down six border control points on January 28, when the number of mainland cases had reached 4,500 cases, with over 100 deaths. By then there eight cases in Hong Kong, all imported.
Four more border control points that handled higher volumes of travellers, such as Lo Wu and Lok Ma Chau, have closed since February 4, when the city reported its first death related to the virus. At that point, Hong Kong had 18 confirmed cases, some of which involved patients potentially with local infection.
Four days later, the government implemented a mandatory 14-day quarantine for all people, regardless of nationality, arriving from the mainland.
A specialist with a public health background, who declined to be named, criticised the government for not raising the alert level when the city reported its first few cases.
“When there is a case, the emergency level of the response plan should be activated immediately,” he said, adding many health care staff had expected the highest level of the three-tier scale to be activated earlier.
The emergency level was activated two days after the first two cases were confirmed in Hong Kong.
He also accused the government of a lack of coordination among officials in combating the epidemic, as medical students, civil servants, and scouts, were urged to help monitor people in quarantine.
“The government is looking for outsiders to help … how could you rely on volunteers when we are in a war?” the doctor said.
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